Background: Although the radiotherapy (RT) effect is reversible in some tissues, it is progressive and permanent for the ovary. Ovary radiation exposure during breast cancer radiotherapy (BCR) may cause concern in patients and obstetricians. In this study, we evaluated ovarian radiation doses in patients who received adjuvant radiotherapy for breast cancer prospectively. Methods: Ovary doses were calculated in patients diagnosed with breast cancer (BC) and receiving RT at the Radiation Oncology clinic of Ankara Bilkent City Hospital. Helical intensity modulated radiotherapy (IMRT) planning and three-dimensional (3D) planning were performed for each patient. Results: The data of 8 patients who received BCR at 8 August 2023 and 19 September 2023 were evaluated prospectively. The median age of the patients was 57 (range 39–65), 4 (50%) had breast conserving surgery (BCS), and 4 (50%) patients underwent modified radical mastectomy (MRM). Four (50%) patients were left sided, while four (50%) patients were right sided. According to our results, the ovarian doses in adjuvant radiotherapy of breast cancer patients who received RT with the 3D technique were zero. In helical IMRT plans, the ipsilateral ovary dose was median 12 (range 10–30) centi Gray (cGy); the contralateral ovary dose was median 8 (range 5–13) cGy. In patients with MRM, ipsilateral ovary dose in helical IMRT plans was median 10 (range 10–13); in patients with BCS, it was median 15 (12–30) cGy. Conclusions: This is the first study to examine ovarian doses in breast cancer radiotherapy on patients. In our study, in which we evaluated eight patients with 2 different RT techniques, the dose values of ovaries in breast cancer radiotherapy were found to be negligible and no measurable dose was noted in 3DRT technique.

Purpose/Objective(s) To observe the changes in anxiety and pain levels according to verbal and/or visual education during brachytherapy (BRT) sessions in locally-advanced cervical cancer or inoperable endometrial cancer patients who were consulted for BRT. Materials/Methods Visual and/or verbal education was performed in 121 patients who were treated with BRT in 9 cancer centers in Turkey and all patients were asked to respond the Beck Anxiety Inventory (BAI) and Visual Facial Anxiety Scale (VFAS) at diagnosis, after educations at the 1st and the last BRT sessions. The patients were categorized into three groups according to type of education (group 1: only verbal, group 2: only visual, and group 3: both verbal and visual education). Friedman and Wilcoxon tests were performed to evaluate changes with education in BAI and VFAS during BRT. BAI and VFAS were compared between groups with Kruskal-Wallis and the Mann-Whitney U tests. Results Only verbal, only visual, and both verbal and visual education was administered to 57 (48%), 37 (31%), and 26 (22%) patients, respectively. During BRT sessions, 77 (64%) patients received analgesia. The median BAI scores at diagnosis, the 1st and the last BRT sessions were similar between groups. While BAI score slightly increased in the 1st BRT session compared scores at diagnosis in group 1 (p=0.039), BAI score in the last BRT session was significantly lower compared to scores in the 1st BRT session in group 2 (p=0.016), and BAI score significantly decreased at the 1st and the last BRT sessions compared to scores at diagnosis in group 3 (p=0.014 for both). BAI scores at diagnosis, the 1st, and the last BRT sessions were similar in patients who received analgesia or any kind of education without analgesia (p=0.314, p=0.178, and p=0.389, respectively). VFAS significantly decreased at the last BRT session compared to the 1st BRT session in group 3 (p=0.014). Although VFAS at the 1st BRT session was significantly higher in group 3 than group 1 and 2 (p=0.003 and p=0.004, respectively), VFAS at the last BRT session in group 3 was similar with group 1 and 2. The VFAS at the 1st BRT session was significantly lower in patients who received analgesia without combination of visual and verbal education than those received combination of visual and verbal education without analgesia (p=0.001), but VFAS at the last BRT session was similar between these subgroup of patients (p=0.052) despite lower rate of analgesia usage in group 3 compared to group 1 and 2 (41% vs 50% vs 9% for group 1, 2, and 3, respectively, p<0.001). Conclusion Administration of any kind of education have similar effects as analgesia on reducing anxiety levels of patients before BRT sessions. Combination of both verbal and visual education has a greater anxiety and pain reducing effect than only verbal or visual education.

Background: The aim of study was to evaluate the oncological results of stereotactic body radiotherapy (SBRT) in de-novo oligometastatic (dOM) disease. Materials and methods: Patients who underwent SBRT for dOM disease in Radiation Oncology Clinic of XXX Hospitals were analyzed retrospectively. The endpoints of the study were overall survival (OS) and disease free survival (DFS). Results: 84 patients with treated between 08.06.2019-15.11.2022 were analyzed.The median follow up was 26 (range 6- 219) months. dOM subgroups were as follows: 37 (44.0%) synchronous dOM (sdOM); 31 (37%) metachronous oligorecurrence (mdOR) and 16 (19.0%) metachronous oligoprogression (mdOP). Grade 1 acute side effects (ASE) were observed in only 1 patient and no grade >= 2 a ASE were observed. Progression was observed in 45 (53.6%) of the patients.The median DFS was 8 (range 1-32) mo,1y DFS was 44.5%; 2y DFS was 26.2%. Significantly higher DFS was obtained in mdOR than sdOM and mdOP [p = 0.020; hazard ratio (HR): 1.6; 95% confidence interval (CI): 0.75-3.68%]. The relationship between response assessment after SBRTand DFS was significant (p < 0.001; HR: 4.8; 95% CI: 1.9-12.2).Twenty-nine (34.5%) patients were ex and 55 (65.5%) were alive.1y OS was 75.6%; 2y OS -61.2%; 3y OS -57.4% and the median OS value has not yet been reached. Lower OS was observed in sdOM compared to mdOP and mdOR (p = 0.035, HR: 0.45; 95% CI: 0.21-0.96). The relationship between response assessment after SBRT and OS was significant (p = 0.017; HR: 6.6; 95% CI: 1.7-25.7). Conclusion: Higher DFS was observed in mdOR patients and lower OS was observed in sdOM patients. SBRT response in dOM patients may be a prognostic factor for DFS and OS.

Objective To investigate the impact of cumulative cisplatin dose on clinical outcomes in locally advanced cervical cancer patients undergoing definitive chemoradiotherapy. Methods A retrospective analysis was conducted on 654 patients with stage IB3-IVA disease treated with definitive chemoradiotherapy. Radiotherapy was applied as external beam pelvic with or without para-aortic radiotherapy and brachytherapy. Concomitant chemotherapy was in the form of weekly or 3 weekly cisplatin. Data on demographics, treatment protocols, cumulative cisplatin dose, adverse effects, and survival outcomes were collected. Statistical analyses, including univariate and multivariate Cox regression models, were used to assess factors influencing progression free survival and overall survival. Results The median cumulative cisplatin dose was 210mg (range 40-320), and >= 200mg in 503 (76.9%) patients. Median follow-up was 35 months (range 1-150). The 5year progression free survival and overall survival rates were 66.9% and 77.1%, respectively. Multivariate analysis identified poor performance status, non-squamous cell histology, presence of lymph node metastases, and hemoglobin <10g/dL before chemoradiotherapy as poor prognostic factors for both progression free survival and overall survival in the whole group. When stage III cases were evaluated separately, the cumulative cisplatin dose <200mg was found to be a significant poor prognostic factor in overall survival (hazard ratio 1.79, 95%confidence interval 1.1 to 3.0, p=0.031). Conclusion Our study showed that a cumulative cisplatin dose >200mg, particularly in patients with lymph node metastases, significantly improved overall survival. Factors such as anemia, toxicity related challenges, and comorbidities were identified as critical considerations in treatment planning. These findings emphasize the balance between maximizing therapeutic efficacy and managing toxicity, guiding personalized treatment approaches for locally advanced cervical cancer.

Introduction/Background To investigate the prognostic factors for survival, the long-term results and toxicities in elderly (≥65years) patients with cervical cancer who underwent definitive radiotherapy/chemoradiotherapy with a cervical cancer diagnosis. Methodology We reviewed the clinical records of 458 patients with cervical cancer .The median age was 71 (65–91). The median treatment dose was 50.4 Gy (45–64).Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS) were evaluated using Kaplan-Meier, log-rank, and Cox regression analyses; p<0.05 was considered statistically significant. Results Median follow-up 48 months (6 -243); The 5-year OS, CSS, DFS, DMFS, and LRFS were 61.6%, 77.5%, 75.6%, 81.1%, and 91.6%, respectively. OS, CSS, DFS, DMFS influencing factors performance status (PS) (p< 0.0001) in univariate analysis, tumor diameter (≤4cm, >4cm) (p= 0.004, p= 0.008, p< 0.0001) histopathology (squamous, adeno and others) (p= 0.001, p< 0.0001), presence of lymph nodes (LN) (p< 0.0001), treatment response (complete, partial, unresponsive) (p< 0,0001) was statistically significant. For OS, age (65–70, 71–79, ≥80) (p< 0.0001), type of treatment (CCRT, RT) (p< 0.0001), Brachytherapy (BT) application (p< 0.0001); BT application for CSS and DMFS (p= 0.025, p= 0.003) and treatment response for LRFS (p< 0.0001) were significant parameters. In multivariate analysis, independent prognostic factors for OS, CSS, DMFS, and DFS, are treatment response (p< 0.0001,p=0.003), LN ( p< 0.0001, p= 0.007, p= 0.002, p= 0.003) and PS for OS, DFS (p= 0.003, p= 0.004), the age for OS (p= 0.045), type of treatment (p< 0.0001). For DMFS, histopathology (p= 0.026) and BT application (p= 0.049) were found to be significant. Conclusion Curative treatments for geriatric patients, especially in locally advanced cervical cancer, have a low rate of side effects but have a favorable effect on survival and definite CRT should be recommended in geriatric age. Disclosures Curative treatments for geriatric patients, especially in locally advanced cervical cancer, have a low rate of side effects but have a favorable effect on survival and definite CRT should be recommended in geriatric age.

Aim: Patients diagnosed with locally advanced and/or metastatic gastric cancer and who cannot undergo surgery may need palliative treatment during their follow-up. There is scarce data about outcomes of palliative gastric radiotherapy (RT). In this study, we aimed to investigate the effect of 3-D external beam RT on oncological outcomes, as a non-invasive method.Material and Method: From 2013 to 2017, sixteen gastric cancer patients treated with palliative external RT in our institutional clinic were evaluated. Only patients who received palliative gastric radiotherapy for obstruction, pain and bleeding were analyzed, and patients who had previously received RT to the abdomen or who were given RT for adjuvant purposes were not included in the analysis. Results: Seven patients (43%) were not able to finish the planned palliative course. Thirty Gray with 10 fractions was the most planned RT schedule. Almost half of the patients (%56) received chemotherapy before RT. Overall survival was found to be median 2 months. Median survival was better in patients who were able to receive 28 Gy bioequivalent dose (4 vs 0.3 months, p≤0.00). Purpose of palliation also found to be a significant factor on survival. Patients who were referred for pain have found to be better survival rather than bleeding and obstruction (13 vs 0.7 months, p=0.03).Conclusion: External radiotherapy is an easily applicable and effective method for palliation in gastric cancer patients. Early referral for radiotherapy in patients who need palliation may increase oncological outcomes. It has been observed that the prognosis is worse in patients who received palliative radiotherapy due to gastric bleeding and obstruction.

Fertility is an important component of quality of life and oncological patients should be questioned about their expectations before treatment. Radiotherapy (RT) can adversely affect fertility irreversibly and progressively. Therefore, patients with expectation of fertility should be evaluated before RT and guided for appropriate interventions. Radiotherapy negatively affects fertility in many aspects. Cranial RT disrupts the hypothalamus-pituitary-ovarian (H-P-O) axis, pelvic RT directly affects the ovary and uterus. Because of the long latent period of endocrinopathies caused by cranial RT, these patients should be followed up for a long time. Due to dose-dependent uterine and ovarian toxicities that develop after abdominopelvic RT, patients are at high risk for infertility and pregnancy complications. Uterus and ovaries have different radiosensitivity depending on age. With aging, radiosensitivity of the uterus decreases, while radiosensitivity of the ovaries increase. Although there is no consensus on the threshold doses that can cause RT-related infertility, according to current data, the threshold value for the hypothalamo-pituitary axis is 30 Gy; 25 Gy for young women and 45 Gy for adult women for the uterus; 10 Gy for acute ovarian failure in the ovary and 25 Gy for premature ovarian failure under 35 years of age. There is no significant relationship between parental radiation exposure and inherited genetic disease in their infants.

ABSTRACT Objective: In this study, patients who underwent salvage Radiotherapy (RT) after biochemical recurrence (BCR) were evaluated retrospectively. The aim of this study was to evaluate the factors affecting the time to biochemical recurrence and salvage RT after radical prostatectomy. Materials and Methods: In XXX Hospital, patients with prostate cancer who received salvage RT between 01.01.2011 and 01.01.2018 were analyzed retrospectively. Patients who had undergone radical prostatectomy for prostate adenocarcinoma, and received salvage RT for PSA (Prostate-specific antigen) recurrence, were included. Patients who received post-surgery hormone therapy, and received definitive or palliative RT, were excluded. SPSS Ver. 22 software package was used for statistical analysis and the statistical significance limit was accepted as p≤0.05. Results: Results of 84 patients who met the criteria of the study were analyzed. The median follow-up was 78.5 (range 28-172) months and the median time between surgery and RT was 23.7 (range 5.1-136.9) months. The relationship between the time from surgery to BCR and the GS was statistically significant; the median time was 16.3 (2.17-125.9) months in the group with GS ≤8, and 8.9 (2.8-20.3) months in the group with GS 9-10 (p=0.05). The relationship between the time from surgery to BCR and T stage was statistically significant. In subgroup analysis, this difference was seen between T3A and T3B stages. That time was 17.8 (range 2.17-73.77) months in T3A and 8.7 (range 2.8-29.6) months in T3B stages (p=0.02). The relationship between the level of nadir PSA and the median time between surgery and BCR was significant. It was median 20.6 (range 5.4-65.2) months in patients with PSA< 0.03 and 8.8 (range 2.2-125.9) months in patients with PSA ≥0.03 (p<0.0001). Conclusion: BCR time is shorter in patients with high GS, advanced T stage, and high postoperative PSA nadir.

The objective of this study was to compare FIGO 1988 and 2009 endometrial carcinoma staging systems in terms of patient distribution and efficacy in predicting prognosis in patients treated with surgery and adjuvant radiotherapy (RT). Medical records of 351 patients treated between 1994 and 2009 were retrospectively analyzed. Adjuvant RT was in the form of vaginal cuff brachytherapy (BRT) in patients with uterine confined disease and risk factors, whereas high-risk patients received risk-adapted external pelvic RT. The median follow-up time was 55 months (range, 2.5-133 months). Five-year overall (OS) and disease-free survival (DFS) for the entire group was 83 and 88%, respectively. Stage migration was observed in 188 (54%) patients. Stage migration generally did not cause any significant effect in OS and DFS rates. However, 5-year OS and DFS for stage I patients with positive peritoneal cytology was significantly lower than the other patients with negative cytology in FIGO 2009 system. The survival curves overlapped for stage IA, IB and II in the new staging system. On the other hand, the division of stage IIIC as IIIC1 and IIIC2 significantly affected the prognosis. Patients with stage IIIC2 tumor had 40% OS and 48% DFS rates compared to 69 and 66% in stage IIIC1 patients (p=0.002). The major improvement of FIGO 2009 seems to be the subclassification of stage IIIC disease into IIIC1 and IIIC2. The positivity of peritoneal cytology per se seems to have an influence in prognosis in our cohort. To withdraw the positive cytology from staging may mislead the prognosis estimation in these patients and lead to undertreatment.

Purpose/Objective(s)The purpose of this study is to determine the efficacy and toxicity of stereotactic body radiotherapy (SBRT) as a salvage treatment in patients with locally persistent and recurrent head and neck carcinomas (HNC).Materials/MethodsBetween July 2007 and November 2008, 35 patients with locally recurrent HNC were treated by SBRT. The sites of disease distribution were as follows: nasopharyngeal cancer, 16; paranasal sinus cancer, 7; oral cavity cancer, 3; hypopharyngeal cancer, 4; laryngeal cancer, 1; thyroid cancer, 1; tracheal cancer,1; lacrimal gland cancer, 1; and parotid cancer; 1. All patients had previously received full dose radical external beam radiotherapy. Median first line radiotherapy dose was 65,5 Gy (range, 30 Gy-77,4 Gy. Time from the previous radiotherapy to SBRT was median 66 months (range, 7-300 months). Ten patients were treated for two or more recurrences and five of these had taken second re-irradiation before SBRT. Median SBRT dose was 30 Gy (18-35 Gy) in median 5 fractions (1-5 fractions) in median 5 days (1-8 days) to typically 75-85% prescription isodoses. Median follow up time was 8 months (range, 4-18 months).ResultsSeven patients had complete regression of tumor after SBRT, eleven had partial response, ten had stable disease, and six had progression of tumor. The overall response rate was 51.4% (n = 18). SBRT established ultimate disease control in 80 % (n = 28) of the patients. Disease progression in six patients occurred in median 6 months (range, 2-9 months) after SBRT. One year survival is 66.7%. Thirteen patients (%37) were complained of grade II-III toxicities; mucositis, dysphagia, feeding tube, fistula, myelitis and soft tissue necrosis. Moreover, three of four patients who have presented with profuse bleeding as life threatening toxicity after 2-3 months of SBRT were died.ConclusionsOur early result is encouraging that SBRT is an effective treatment modality with relatively good disease control for recurrent head and neck cancer. Major treatment related mortality is bleeding. Longer follow up with increased number of patients is essential to determine the definitive role of SBRT in this group of patients. Purpose/Objective(s)The purpose of this study is to determine the efficacy and toxicity of stereotactic body radiotherapy (SBRT) as a salvage treatment in patients with locally persistent and recurrent head and neck carcinomas (HNC). The purpose of this study is to determine the efficacy and toxicity of stereotactic body radiotherapy (SBRT) as a salvage treatment in patients with locally persistent and recurrent head and neck carcinomas (HNC). Materials/MethodsBetween July 2007 and November 2008, 35 patients with locally recurrent HNC were treated by SBRT. The sites of disease distribution were as follows: nasopharyngeal cancer, 16; paranasal sinus cancer, 7; oral cavity cancer, 3; hypopharyngeal cancer, 4; laryngeal cancer, 1; thyroid cancer, 1; tracheal cancer,1; lacrimal gland cancer, 1; and parotid cancer; 1. All patients had previously received full dose radical external beam radiotherapy. Median first line radiotherapy dose was 65,5 Gy (range, 30 Gy-77,4 Gy. Time from the previous radiotherapy to SBRT was median 66 months (range, 7-300 months). Ten patients were treated for two or more recurrences and five of these had taken second re-irradiation before SBRT. Median SBRT dose was 30 Gy (18-35 Gy) in median 5 fractions (1-5 fractions) in median 5 days (1-8 days) to typically 75-85% prescription isodoses. Median follow up time was 8 months (range, 4-18 months). Between July 2007 and November 2008, 35 patients with locally recurrent HNC were treated by SBRT. The sites of disease distribution were as follows: nasopharyngeal cancer, 16; paranasal sinus cancer, 7; oral cavity cancer, 3; hypopharyngeal cancer, 4; laryngeal cancer, 1; thyroid cancer, 1; tracheal cancer,1; lacrimal gland cancer, 1; and parotid cancer; 1. All patients had previously received full dose radical external beam radiotherapy. Median first line radiotherapy dose was 65,5 Gy (range, 30 Gy-77,4 Gy. Time from the previous radiotherapy to SBRT was median 66 months (range, 7-300 months). Ten patients were treated for two or more recurrences and five of these had taken second re-irradiation before SBRT. Median SBRT dose was 30 Gy (18-35 Gy) in median 5 fractions (1-5 fractions) in median 5 days (1-8 days) to typically 75-85% prescription isodoses. Median follow up time was 8 months (range, 4-18 months). ResultsSeven patients had complete regression of tumor after SBRT, eleven had partial response, ten had stable disease, and six had progression of tumor. The overall response rate was 51.4% (n = 18). SBRT established ultimate disease control in 80 % (n = 28) of the patients. Disease progression in six patients occurred in median 6 months (range, 2-9 months) after SBRT. One year survival is 66.7%. Thirteen patients (%37) were complained of grade II-III toxicities; mucositis, dysphagia, feeding tube, fistula, myelitis and soft tissue necrosis. Moreover, three of four patients who have presented with profuse bleeding as life threatening toxicity after 2-3 months of SBRT were died. Seven patients had complete regression of tumor after SBRT, eleven had partial response, ten had stable disease, and six had progression of tumor. The overall response rate was 51.4% (n = 18). SBRT established ultimate disease control in 80 % (n = 28) of the patients. Disease progression in six patients occurred in median 6 months (range, 2-9 months) after SBRT. One year survival is 66.7%. Thirteen patients (%37) were complained of grade II-III toxicities; mucositis, dysphagia, feeding tube, fistula, myelitis and soft tissue necrosis. Moreover, three of four patients who have presented with profuse bleeding as life threatening toxicity after 2-3 months of SBRT were died. ConclusionsOur early result is encouraging that SBRT is an effective treatment modality with relatively good disease control for recurrent head and neck cancer. Major treatment related mortality is bleeding. Longer follow up with increased number of patients is essential to determine the definitive role of SBRT in this group of patients. Our early result is encouraging that SBRT is an effective treatment modality with relatively good disease control for recurrent head and neck cancer. Major treatment related mortality is bleeding. Longer follow up with increased number of patients is essential to determine the definitive role of SBRT in this group of patients.